Given that I know very little about Tibetan medicine, I'm not sure how to frame this post.

My body has been giving up on me for years now, and I suffer from classical metabolical syndrome. Over some months, though, I lost a great deal of weight and probably felt better than I had done for a long time.

Towards the end of last July, however, something went suddenly and badly wrong. A collegue and I ran a workshop in a rural area, and on the day of our return to Cape Town we had our lunch at a farm-based canteen on the way back to Cape Town. We ordered different things. An hour of ninety minutes later, I started feeling weak and tired. The sky was misty but the sun was bright, and I noticed that my vision seemed "whited out" as if I was surrounded by snow and as if my vision was compromised by the light reflected by snow. Perception of colour, when not in shade, was shifted towards white, and I became unable to see edges -- pavements, and so on. Back home, I lay down for a while and my vision seemed to right itself; but from then on I had spells of vertigo or syncope which were brought on by even very minor effort -- walking to the lavatory, for example. I was persuaded to see my GP, who ran blood-tests and determined that I was seriously anaemic, something new and unexpected.

After tests for internal bleeding -- gastroscopy, colonoscopy, CT-scan and testing for occult blood, which revealed no internal bleeding, I had to go into hospital for a substantial blood-transfusion as well as an iron infusion towards the end of August, which raised my haemoglobin level somewhat but did not solve the problem. I was then referred to a haematologist, who did a bone-marrow biopsy. Blood-work showed that my haemoglobin was once again severely low, and the biopsy showed that my iron stores and stores of vitamin B-12 were completely depleted.

Into hospital again for another massive iron infusion -- enough, I was told, to last a lifetime. That was around the end of last November. I also have regular vitamin B-12 injections -- initially once a week, but now once a month. Tests around a month later showed some rise in haemoglobin level and I became somewhat stronger for a while, but the weakness and syncope returned with a vengeance. Even the mildest exertion led to dull aching in the chest which radiated to the back and down the left arm as well as syncope, and there were times when I thought that death was imminent, though this was not something about which I felt anxious. I can think of far worse ways to die. My impression was that the aching was connected with shortage of oxygen: I was feeling breathless although able to breath without significant impediment, which suggested that part of the problem, at least, was that my body was not able to absorb sufficient oxygen. I insisted that new blood studies be done, and they confirmed this. My haemoglobin levels had dropped sharply once again, and my Ferritin levels were down to 6, where the iron infusion had raised them to 200 or more.

Into hospital yet again for yet another massive iron infusion, in May. One month later, bloodwork showed a rise in my haemoglobin levels similar to the pattern after the previous infusions, and a similar rise in Ferritin level, but it was clear that the odds are that these will plummet again. The haematologist is reluctant to look for the cause, and this has been frustrating me. He insists that there has to be internal bleeding, though tests show no evidence of it, and is unwilling to investigate further on the grounds that this is expensive. My Medical Aid scheme seems likely to become unhappy about further iron infusions, and given the speed at which my body seems to deplete iron stores, any miscalculation could be fatal in any case.

Something which has exercised me throughout this saga is the fact that the onset was sudden, dateable and virtually timeable. Any attempt at an explanation needs to account for this. The stories I've been given -- bleeding so gradual that it is undetectable, but which mounts up over time to a substantial loss of blood -- do not make sense. There should have been warning signs in bloodwork done not long before the onset, and the signs should have come on more gradually. My personal hypothesis is that I may have ingested some kind of agricultural tozin at the farm on the way back to Cape Town late last July, something which interferes with iron absorption. There might have been a drop or smear of something on a surface. I know from the experience of working on a farm one summer vacation as a student that highly toxic substances -- systemics and heaven knows what else -- tend to be handled without too much care, familiarity breeding a degree of contempt. Something like this would account for the suddenness of the onset of the problems. My concern is that no cure will be possible unless an aetiology is determined, and the unwillingness of the haematologist to determine the actual cause by means of any evidence-based procedure feels like a triage decisionwhich writes my life off.

Forgive me for not knowing how to couch this in terms which relate to Tibetan medicine. What I wonder is whether Tibetan medicine can shed any light on all of this.

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